Primary care doctors are encouraged to screen patients for alcohol use and provide brief counseling when needed. This preventive approach, known as alcohol screening and brief counseling (ASBC), can help identify risky drinking patterns early. However, new research examining data from 2013 to 2019 reveals troubling trends: not only does ASBC remain uncommon, but access to this care has become increasingly unequal across racial and insurance groups.
What is Alcohol Screening and Brief Counseling?
ASBC involves several steps. Healthcare providers ask patients about how much alcohol they drink (quantity screening). For those who report concerning levels, providers assess whether they’re experiencing problems related to drinking (problem assessment), offer brief counseling about reducing consumption, and provide information about treatment options when needed.
The Study
Researchers analyzed responses from over 150,000 adults ages 18 to 64 who had consumed alcohol and visited a primary care provider in the past year. The data came from the National Surveys on Drug Use and Health conducted between 2013 and 2019, a period following U.S. health reforms that increased primary care access for underserved groups and provided support for ASBC in primary care.
The researchers examined three groups based on drinking severity: those without heavy drinking or alcohol use disorder (AUD), those who engaged in heavy drinking but didn’t have AUD, and those with AUD. They looked at trends over time and compared rates across different insurance types and racial and ethnic groups.
Persistently Low Rates
The findings show that across all years studied, rates of most ASBC services remained low. Among people who drank heavily but didn’t have AUD, 10.1% or fewer received problem assessments, and 4% or fewer received brief counseling. Among those with AUD, 16.4 to 17.3% received problem assessments and 14.9 to 15.6% received brief counseling.
While there were some increases over time, the improvements were modest. The largest increase was in quantity assessment (asking how much people drink), which grew by less than 8.6 percentage points. Other services increased by less than 2 percentage points.
Growing Differences
The pattern of who received these services revealed significant differences. White adults showed increases in all types of ASBC services. People with private insurance showed increases in quantity and problem assessment. These increases were not seen across all groups, creating widening gaps.
The difference in quantity screening between White and Black adults increased substantially. Among individuals who drank heavily, the White-Black difference in quantity assessment increased nearly four-fold. Among those who did not drink heavily, it increased almost three-fold. Insurance-based differences also increased over time.
What This Means
These findings indicate that evidence-based alcohol preventive care became increasingly inequitable during the study period. The researchers conclude that interventions to increase ASBC generally, and particularly for underserved groups, are warranted.
The study examined the period from 2013 to 2019, showing that despite health reforms during this time, both overall rates of alcohol screening and counseling remained low and differences between groups widened.
Cook, W. K., Ye, Y., Zhu, Y., Karriker-Jaffe, K. J., & Mulia, N. (2025). Trends and disparities in alcohol screening and brief counseling following the U.S. Affordable Care Act. Drug and alcohol dependence, 268, 112558. https://doi.org/10.1016/j.drugalcdep.2025.112558
